Background: An ageing society and rising prevalence in dementia are associated with rising demand for care home places. Monitoring technologies (e.g. bed-exit alarms; wearable location-tracking devices) are appealing because of their potential to enhance safety, increase resident freedom, and reduce staff burden. However, it is unclear how far use of such technologies can deliver potential benefits, and there are ethical challenges from their use. This study explored the implementation of monitoring technologies in care homes for people with dementia, to identify facilitators and barriers to the implementation of these technologies in practice. Methods: An embedded multiple-case study design was employed with 3 dementia-specialist care homes in North-West England. Data collection included 36 semi-structured interviews with staff, relatives and residents, informed by Normalization Process Theory to focus on individual and organisational factors within implementation; 175 hours’ non-participant observation; investigation of care records and technology manufacturer literature; and questionnaires to establish participant attitudes towards technologies. Qualitative data were analysed using Framework Analysis. Findings: 5 overarching themes emerged: (1) Reasons for using technologies; (2) How technologies were implemented; (3) What happened when using technologies; (4) Understanding of technologies; (5) Business and environmental influences. Mitigation of risk seemed to override other potential benefits (e.g. resident freedom) or ethical concerns (e.g. the remote monitoring of residents with impaired cognition), as a reason for use. This emphasis seemed to position monitoring technologies as being understood as fundamentally different to other interventions, and challenged adherence to philosophies of care emphasising resident choice. Some staff, relatives and residents did not seem to be involved in discussion and decision-making regarding technologies, and seemed to lack knowledge about technologies within the homes. Staff training appeared mainly informal, based upon assumptions of simplicity of use, which might not have been sufficient to ensure that staff fully understood the technologies. Staff understanding and awareness of the technologies appeared to be influenced in part by location, both organisationally (i.e. their role) and physically (i.e. within the building). Technical and physical properties of the technologies appeared to work in relation with the physical environments of the homes, which suggested that there may not be an ideal set of physical properties for any particular technology. Some technologies offered a range of functional and information-gathering capabilities, which at times were perceived to be useful complements to practice, but at other times less useful, particularly if they were imbued with a financial cost that was not justifiable from a business perspective. Conclusions: Care homes may need to consider greater involvement of all stakeholders in discussions and decisions regarding the use of monitoring technologies, in order to deepen understandings about the potential benefits and challenges from their use. There is also a need to consider the technical compatibility of technologies with the care home premises, and the financial implications from investing in technologies.

In Scotland, as in many other welfare states, the organisation of care homes for older people takes place in a highly contested space where debates about demographics, limited financing and changing expectations of the state compete with questions about choice, rights, equality and models of care. These services intersect the formal boundaries of the public and private sectors as well as the lines between public and private life. The production of care home services crosses several policy spheres, including local governments, the devolved Scottish administration and the UK government and includes numerous organisational bodies, such as care home providers, the care regulator and the voluntary sector. At the centre of this intersection lies the work of contracting and the production of a national framework agreement for care home services in Scotland called the National Care Homes Contract (NCHC). This contract is both the bridge between the public and private sector and a formalised link between the individual and the institution. In this thesis, I depict the NCHC document as an artefact which links these spheres and the work of contracting as the practice of maintaining that relationship. I take up the concept of boundary objects and suggest that the NCHC functions as a bridge between multiple fields of practice and is a useful tool for understanding the competing perspectives of people who plan and deliver care home services in Scotland. In this thesis, I reveal the different, and at times competing, perspectives which surround care home services for older people and the stabilising work that is undertaken to manage these differences. This research utilises an interpretive approach to examine the creation and ongoing implementation of the NCHC. Fieldwork for this research was conducted over 12 months and includes interviews with local authority planners and contract managers as well as care home owners and managers from the independent and third sector, each of whom do particular kinds of work to create, implement and use the text. A textual analysis of the framework agreement is also used to support this research. I examine the work of making, re-­‐making and using the NCHC at three levels: national policy actors, local government contract managers, and managers of local care homes. Each group undertakes a kind of policy work: first to create the NCHC, then to implement it in local jurisdictions and finally to use it within local service delivery. Stabilising work takes three primary forms: text work designed to stabilise meaning, relational work designed to translate meaning across boundaries of practice, and ethical work, a value-­‐ based emotional work that underpins the first two kinds of everyday labour. I suggest that this work is first and foremost driven by a need to stabilise the care home sector and that it is deliberative in nature and conflict ridden such that the use of the contract in practice is often resisted. In working to stabilise this system, the values of this work come into conflict – triggering both caring and resistance responses within the sector. In giving an account of stabilisation, I provide a micro-­‐sociology of the meaning making, relationship-­‐building and conflict which underpins policy work. I draw conclusions from this about the discretion of policy actors at all levels of the system, the rational-­‐technical and emotional nature of their work, and the unexpectedly deliberative policy space of contracting in Scotland.

Improving medication management at transitions of care is a national and international priority. People with dementia, who transition between hospitals and care homes, can be at an increased risk of adverse events, harm and costly re-hospitalisation. There is limited research which examines factors which may influence the quality and continuity of medication management in this context, particularly in the UK. This research uses a systems approach to explore the factors which may influence the quality and continuity of medication management when people, with dementia, move between the care home and hospital setting. This multi method, multi-phase study included interviews with hospital staff, care home staff, residents with dementia and relatives and examination of policies and documents used to support medication management at transition. Overall, policy recommendations and implementation strategies to support medication management at transition were limited. Residents, staff and relatives emphasised the importance of administration routines and preferences, but there were no strategies to support the communication of this information. Procedures, tools and training to support care homes based medication reconciliation was also limited. Residents and relatives were rarely involved in medication management due to limited resources and decision making. This sustained, rather than challenged, the power imbalance between residents and staff. Better defined roles and integrated processes which take account of the needs of this transition may help residents, relatives and care home staff to feel valued and empowered to provide information which supports person-centred medication management and boost resilience by helping to identify medication errors or adverse events. / Alzheimer’s Society

Yes / In England, care homes for older people have been subject to four different regulatory bodies within the last six years (see Table 1). The government has announced further change with the creation of a new regulator of adult health and social care in 2009 (CSCI, 2007). The current regulatory body, the Commission for Social Care Inspection (CSCI) will merge with the Healthcare Commission and the Mental Health Act Commission to create the Care Quality Commission. The Department of Health (DOH) is currently reviewing the future regulation of health and adult social care in England (DOH, 2005; DOH, 2006a) and the way that CSCI carries out the regulation and inspection of a range of social care agencies including care homes for older people. Substantial reforms of the regulatory system of regulation and inspection were embodied in the Care Standards Act (CSA) 2000 that was part of the wider Government agenda to modernize health and social care services. The Act established new regulatory bodies for care services and workers and along with the regulations and mandatory National Minimum Standards (NMS) created a framework to ensure greater consistency of quality and to better protect vulnerable children and adults (Engelman and Spencer, 2003). The impact of these changes for both inspectors and providers of care services has been significant. Regulators have had to adjust and adopt new ways of working whilst carrying out their statutory responsibilities. Care providers have had to respond to the revised changes in standards and requirements of registration. This article examines inspection as a mechanism for improving the quality of care standards. It reports on a study conducted in 2004 that sought the views of managers of care homes for older people about the NMS and the inspection process at that time. The role of inspectors will be considered in light of the findings and published literature.

No / Since 2001 the Trebus Project has been collecting first-person narrative biographies of people with dementia, the majority of whom were living in UK care homes. In 2012 David Clegg, the director of the Trebus Project, received funding from the Wellcome Trust's Arts Awards to carry out an interdisciplinary exploration of the narratives of three people with dementia who, by coincidence, had occupied the same care home room (Room 21) at different times. Analysis of the three narratives to date has discovered some uncanny echoes and resonances. The narrators make frequent reference to other rooms which are temporally or spatially connected with Room 21 in some way. There are worm-hole-like exits and entrances to past times and places, and intimations of other rooms within, behind, and underneath this present living space. At points, events in national and social history sheer dizzyingly away from the accounts of them we have inherited from official sources. Extracts from the narratives of Room 21's three inhabitants, Frances, Peter and Shirley, will be presented in a way that juxtaposes the experience of dementia and post-war postmodern consciousness: liminal, fragmentary, frequently surreal, and beyond the reach of universalising accounts of either the 'illness experience' or revisionist history. Plans to disseminate the findings of the project by means of film and dramatic reconstruction will be discussed.

Darbo tikslas. Įvertinti Klaipėdos apskrities vaikų globos namų auklėtinių ir administracijos darbuotojų požiūrį į sveikatos stiprinimo galimybes bei poreikį Klaipėdos apskrities vaikų globos namuose. Tyrimo metodika. Atlikta anoniminė Klaipėdos apskrities vaikų globos namų auklėtinių (12 – 18 metų amžiaus) apklausa. Pusiau struktūrizuotame interviu dalyvavo 18 Klaipėdos vaikų globos namų administracijos darbuotojų. Rezultatai apdoroti SPSS 17.0 versija ir MS Excel. Statistinis duomenų reikšmingumas buvo tiriamas naudojant Chi kvadrato (2) kriterijų, laisvės laipsnių skaičių (lls) bei statistinį reikšmingumą (p). Rezultatai laikomi statistiškai patikimais, kai p<0,05. Rezultatai. Dauguma respondentų yra vidutinių gabumų mokiniai, kurie savo sveikatą vertina kaip „labai gerą arba gerą“ (66,9 proc.). Vaikų globos namuose gyvenančios mergaitės savo sveikatą nori pagerinti daugiausiai dėmesio skiriant sveikatos stiprinimui (sveikai mitybai ir fiziniam aktyvumui), o berniukai – žalingų įpročių atsisakymui. Priklausomybę sukeliančių medžiagų vartojimo ypatybių analizė parodė, kad daugiausiai vaikų globos namų auklėtinių (didžiausias procentas) vartoja alkoholinius gėrimus (75,4 proc.), 44,4 proc. – yra bandę rūkyti arba ir šiuo metu rūko. Bent kartą kitas priklausomybę sukeliančias medžiagas yra bandę 38,1 proc. vaikų globos namų auklėtinių. Tyrimo metu nustatyta, kad statistiškai patikimai dažniau berniukai ir vyresnio amžiaus vaikų globos namų auklėtiniai rūko, vartoja... [toliau žr. visą tekstą] / Aim of the study: To evaluate the approach of administrators and juvenile wards to health promotion opportunities and demands in Klaipeda county children’s foster care homes. Research methods: An anonymous survey amongst juvenile wards of Klaipeda county children’s foster care homes (age range: 12-18) was carried out. Additionally, partly-structured interviews of 18 Klaipeda county children’s foster care home administrators were conducted. The results have been processed using SPSS Version 17.0 and MS Excel. The statistic importance of the data was investigated using the criterion of Chi-square (2), the number of the degree of freedom (df) and statistical significance (p). Results were considered statistically reliable if p<0.05. Results: Most of the juvenile respondents are schoolchildren with medium-level capabilities, who evaluated their health status as ‘very good’ or ‘good’ (66.9%). The girls who are living in foster care homes want to improve their health by paying greater attention to health promotion (healthy nutrition and physical activity), while boys want to emphasise anti-addiction work. An analysis of the use of addictive substances shows that the majority (75.4%) of the children in foster care homes are taking stimulants, 44.4% have tried or are using cigarettes. At least once in their lifetime 38.1% of juvenile respondents have tried one or more addictive substances. The research identify as statistically significant the fact that more often boys and older... [to full text]

Allteftersom livslängden ökar i Sveriges demografiska struktur höjs andelen äldre i befolkningen vilket skapar en ökad efterfrågan av äldreomsorg. För att möta denna efterfrågan krävs ny kunskap, förändringar och förbättringar om hur vi i framtiden kan garantera våra äldre god vårdkvalitet. Genom att använda en mixed-methods design bestående utav datainsamling från kvalitativa och kvantitativa observationer är denna studies syfte att undersöka och beskriva interaktionen mellan vårdgivare och vårdtagare utifrån ett teoretiskt ramverk baserat på social resursteori och en modell för interpersonellt resursutbyte. Studiens primära forskningsfråga är att undersöka vilka interpersonella resurser som utbyts mellan vårdgivare och vårdtagare. Studiens resultat rapporterar att ett brett spektrum av resurser utbyts mellan aktörerna och analysen presenterar två komplimenterande teoretiska dimensioner i vilka olika typer av resursutbyten sker, en socialt orienterad dimension och en uppgiftsorienterad dimension. Denna begreppsbildning möjliggör för en bättre förståelse av de befintliga resursutbyten som utgör interaktionen mellan vårdgivare och vårdtagare då olika resursutbyten kräver olika förutsättningar eller förkunskaper. De kvantitativa resultaten gav stöd till denna teoretiska utveckling som visar att utbyte av socialt orienterade och uppgiftsorienterade resurser inte skedde samtidigt. Slutaktligen kan analysen i denna studie ge vårdgivare, institutioner och organisationer en bättre förståelse för villkoren de olika resursutbytena kräver. Att säkerställa kontinuiteten mellan vårdtagare och vårdgivare möjliggör för långsiktiga och kultiverade relationer, vilket gör socio-dimensionella utbyten mer sannolikare. Social resursteori är potentiellt användbar för att förstå interaktionen mellan vårdgivare och vårtagare i vårdsammanhang. / As life-expectancy rises in the demographic structure of Sweden, the population of elderly citizens steadily increases. To meet the increasing demand of elderly care, new knowledge about how we will grant our elderly good quality care is needed as changes and improvements in public health care becomes increasingly of importance. This study have primary focus on residental care homes in Sweden. Using mixed-methods consisting of data collection using qualitative and quantitative observations, the purpose of this study is to examine and describe the interactions between caregivers and caretakers using a theoretical framework based on social resource theory and a model of interpersonal resource exchange. The primary research question of this study is to examine which interpersonal resources is exchanged between caregivers and caretakers. The results reported a wide range of resource exchange between caregivers and caretakers in the residental care home context. The analysis demonstrated two complimentary theoretical dimensions in which different types of resource exchanges takes place, a social oriented dimension and a task oriented dimension. This conceptualization allows for a better understanding of the existing resource exchanges that constitutes the caregiver-caretaker interaction as certain exchanges requires different prerequisities. Quantitative findings from observations supported this theoretical development, showing that exchanges of social oriented and task oriented resources did not occur concurrently. Conclusively, the analysis presented in this study can provide health care providers, institutions and organizations a better understanding for these different conditions of exchange. Ensuring continuity between caretakers and caregivers enables long-term and cultivated relationships, thus making socio-dimensional exchanges more likely. Social resource theory is potentially useful for understanding interactions between caregivers and caretakers in the residental care home context.

Syfte: Att undersöka hur sjuksköterskor inom särskilt boende resonerar kring kvalitetsuppföljningar och dess eventuella konsekvenser för omvårdnaden. Metod: Semistrukturerade intervjuer efter öppen intervjuguide med sex sjuksköterskor. Kvalitativ innehållsanalys enligt Graneheim och Lundmans metod. Huvudresultat: I vilken grad kvalitetsregistren och kvalitetsuppföljningarna integreras i omvårdnadsarbetet och dess utveckling är centralt för om dessa uppfattas som stöd eller hinder för god kvalité i omvårdnaden. Dubbel dokumentation bidrar till att sjuksköterskorna omprioriterar arbetstiden och arbetar mer konsultativt och administrativt. Detta minskar tiden för omvårdnadsobservationer och handleding av omvårdnadspersonal samt gör att kvalitetsregistreringar snarast uppfattas som ett hinder. Sjuksköterskorna använde sin professionella kunskap och kliniska erfarenhet i högre grad än registerdata vid omvårdnadsbedömningar. Dessa sågs som alltför komplexa för att kunna fångas i kryssfrågeformulär. Mer kliniska observationer efterfrågas i kvalitetsuppföljningarna för ökad medvetenhet om hög arbetsbelastning och dess eventuella konsekvenser samt för att garantera de boende god omvårdnadskvalité. Konklusion: Sjuksköterskorna upplever att de arbetar under svår tidspress. Tiden anges som essentiell för vilken omvårdnadskvalité som erbjuds. Vid beslut om registreringar av kvalitetsindikatorer bör sjuksköterskornas totala arbetsbörda beaktas. Registreringarna bör integreras i befintliga journalsystem så att sjuksköterskornas omprioriteringar inte får negativa konsekvenser för omvårdnadskvaliten. / Objective: How nurses in residential care reflect on quality follow-ups and its possible consequences for nursing care. Method: Semi-structured interviews with six nurses. Qualitative content analysis according to Graneheim and Lundman's method. Main Results: To witch degree quality follow-ups and national quality registers are integrated in Nursing care and its development is central to if these are seen as support or as obstacle to good nursing care quality. Double documentation contributes to nurses working more consultative and administrative. This reduces the time for nursing observations and guiding the nursing staff as well as contributes to national quality registers being perceived as hindrance. The nurses used their professional expertise and clinical experience to a greater degree than registry data in nursing care assessments. These were seen as too complex to be captured in questionnaires. Conclusion: The nurses perceive that they work under severe time constraints. Time is specified as essential for quality of nursing care. In decisions about quality indicators registrations nurses’ total workload should be taken into account. Registrations should be integrated into medical record used so nurses’ re-prioritizations not have negative consequences for nursing care quality.

For the elders to age with dignity and with an old age that consist of comfort and self-determination, care should be person-centered. A person-centered care sees the person as an individual and not to the disease and diagnostics of the person. A person-centered care is based upon the free individuality of every person and that the need of care is individual. The role of the nurse in a person-centered care is to through its managerial, make sure that the staff have the right knowledge and lead the staff based on the patient’s perspective. The nurse and the staff should build a relationship with both the patient and its relatives, for a better possibility to take part of the patient’s life story. A life story has a large meaning because the person gets to be the focal point and not the disease. The patient story also contributes to the basis of a united perspective within care. The framework of qualification that has been used is the 6 S which is a model for a person-centered palliative care. By using a person-centered approach already when moving to a nursing and care homes may care tailored to individual needs and preferences. The purpose of this study was to clarify the advance of person-centered care with the support of the 6 S model. The method chosen for this study was literary study. Thirteen scientific articles were chosen and examined. The articles were searched in two databases, PubMed and Cinahl, where search words were leading the searches. The result shows that the life story may contribute to a percept higher life quality by following the wishes of the person. The conclusion in this study shows that a person-centered care gives the possibility of a higher life quality for the elderly. The conclusion also shows that a person-centered care provides an opportunity for increased quality of life and promotes the opportunity for a dignified life for the older man. To make this possible for older people it is important that health care staff are attentive to the elderly person's integrity and support the elderly in creating a meaningful life / För att äldre ska kunna åldras med värdighet och med en ålderdom som innefattar välbefinnande och självbestämmande bör omvårdnaden vara personcentrerad. En personcentrerad omvårdnad ser till personen som individ och inte till personens sjukdomar och diagnoser. Personcentrerad vård utgår från att varje person är en fri individ och att omvårdnadsbehovet är individuellt. Sjuksköterskans roll i en personcentrerad omvårdnad är att genom sin arbetsledande funktion omse att personalen har kunskap samt att leda personalen i att utgå från patientens synsätt. Sjuksköterskan och personalen bör bygga upp en relation både med den boende och med dennes anhöriga och närstående för att få möjlighet att ta del av patientens livsberättelse. En livsberättelse har stor betydelse för att personen och inte sjukdomen står i centrum. Livsberättelsen bidrar också till att lägga grunden för ett gemensamt synsätt inom omvårdnaden. Referensramen som använts är De 6S:n som är en modell för personcentrerad palliativ vård. Genom att använda ett personcentrerat synsätt redan vid inflyttning på vård och omsorgsboende kan omvårdnaden anpassas till personens behov och önskemål.   Syftet med studien var att belysa främjandet av personcentrerad omvårdnad med stöd av modellen De 6 S:n. Till denna studie valdes som metod en litteraturstudie. Tretton vetenskapliga artiklar valdes ut och granskades. Artiklarna söktes i två databaser, utifrån relevanta sökord i Cinahl och PubMed. Resultatet visade att genom att utgå från personens önskemål och införliva livsberättelsen som en del i den personcentrerade vården ökade den upplevda livskvalitén hos den äldre människan. Slutsatsen visar även att en personcentrerad vård ger en möjlighet till en ökad livskvalité och främjar möjlighet till ett värdigt liv för den äldre människan. För att göra detta möjligt för äldre människor är det viktigt att vård och omsorgspersonal är lyhörda för den äldres integritet och stödjer den äldre i att skapa en meningsfull vardag.

The purpose of this study is to understand the collaboration between the head of unit, coordinators and accommodation supervisors in a residential care homes for children. It also aims to critically analyze how the staff experience the effects of an increased workload which caused the organization to the reorganize. This requires good interaction between the different functions in the organization which is the primary focus of this study. The study analyzes how the reorganization affects collaboration between the professions and examines what effect the organizations’ different functions have on collaboration. The coordinator has a new function in the organization and that involves a new condition that needs to be emphasized. The study is based on seven semi-structured interviews. Theories that have been the basis for the analysis is Lipskys theories of street-level bureaucracy and discretion as well as interaction based on i.a. Danemarks theories. The result of the essay shows that the professions are effected by the increased work overload. They therefor request clearness in their function and role in the organization. Simply the time is not enough and major difficulties occur for the personal to handle the lodge and at the same time have time for the children living there. The reorganization is also an effect of the collaboration between the professions.